Dear Neil and HIFA
The context, rural Madagascar, suggests isolation, poverty, lack of access to facilities and very low quality healthcare. In addition, incontinence is probably a taboo issue, rarely talked about and unlikely to be addressed. There are plenty of reasons for delaying or avoiding treatment, for OF and anything else, so the prominence of 'fear of organ removal and/or death' seems strange.
To your question about where these rumours come from, Neil, I would say that if the word 'trafficking' is used, this one comes from the media. That's why I draw attention to the lynching of several people in 2013, said to be because of rumours about harvesting organs for trafficking (also pedophilia and dealing in precious gems). I think that also sheds light on why this happened in Madagascar.
How do such rumours emerge? If this had happened some years before, 'organ trafficking' probably would have been referred to as the 'organ trade'. Before that, perhaps 'white slavery' or something similar. And while rumours about organs being removed for transplants could only date back to when transplants became more common, rumors about human body parts being used for occult purposes or satanic practices might date back even longer.
Therefore, there is no chicken and egg scenario here. Today's rumours seem to have some connection with yesterday's, or last century's. The latest rumour is based on an earlier one, and so on. Many of these rumours don't seem to come from the village, nor do I agree that those from the village and those from the media are mutually reinforcing. I think those from the media are more like memes, perhaps a sort of journalist's toolbox.
I agree that it would be interesting to know how much misinformation comes from the media, and how much emerges within communities and is spread person to person. But my experience of social media such as Twitter is that rumours are often spread by sharing articles and items from mainstream media, sometimes with a gloss or opinion.
Tanzania has done a lot to restrict the freedom of journalists and individuals to write about and discuss things via social media. But I haven't heard of any such measures taken to reduce the spread of health misinformation!
HIFA profile: Simon Collery is an Independent Consultant working in Tanzania and is currently director of The Toa Nafasi Project, training young women to provide special needs education to children in their first and second year at Tanzanian state schools. collery AT googlemail.com